A Louisiana law that could close all of the state’s abortion facilities by requiring providers to have hospital admitting privileges would force three-quarters of the state’s women to travel 150 miles or more each way for services, an analysis by ANSIRH researchers has found.

Researchers looked at data from the 5,641 women who received abortions at three of Louisiana’s five facilities between Sept. 1, 2013, and Aug. 31, 2014, the year before the admitting privileges law was scheduled to go into effect. About 80 percent of these women lived in Louisiana; the rest came from other states, mostly Texas.

Louisiana requires the facilities to collect the women’s place of residence, among other data, and the researchers were able to measure the distance that women currently travel for an abortion and how far they would have to travel if all of Louisiana’s facilities closed as a result of the admitting privileges law. The results were published Wednesday, March 4, in Contraception.

The data showed that the Louisiana women in the study had traveled, on average, 58 miles each way to have an abortion. If all of Louisiana’s facilities close, the researchers estimate the average distance would more than triple to 208 miles each way, about the distance from New York to Boston or New Orleans to Jackson.

The authors note that the study may actually underestimate the distance women would have to travel, since three of the closest states to Louisiana—Texas, Mississippi and Alabama—also have passed admitting privilege laws and other restrictions that could close more abortion facilities. Since the Texas admitting privileges law took effect, it has caused almost half of that state’s abortion facilities to close. All of these laws, including Louisiana’s, have been challenged in court.

Researchers noted that forcing Louisiana women to travel further would likely add to financial difficulties that women already have paying for abortion and contribute to delays in receipt of abortion care.

“Abortion is already a safe procedure, and there’s no evidence that admitting privileges would make it any safer,” said first author Sarah Roberts, DrPH, an assistant professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences.

Increased access to oral contraceptives would result in public sector cost savings, study finds

Researchers at ANSIRH/UCSF and Ibis Reproductive Health have just published a study in Contraception on how making oral contraceptive pills (OCPs) available without a prescription could affect contraceptive use, unintended pregnancies and associated contraceptive and pregnancy costs among low-income women.

Based on published figures, the study looked at two scenarios—low over-the-counter (OTC) use and high OTC use—of the proportion of low-income women likely to switch to an OTC pill and predicted the rate of adoption of OCPs based on cost. Twenty-one percent of low-income women at risk for unintended pregnancy were found to be very likely to use OCPs if they were available over the counter (OTC).

In addition, women’s use of OTC OCPs was found to vary widely depending on the out-of-pocket pill pack cost. In a scenario assuming no out-of-pocket costs for the OTC pill, an additional 11–21% of low-income women would use the pill. This would result in a 20–36% decrease in the number of women using no contraception or a method less effective than the pill. Depending on the level of use and related contraceptive failure rates, that would translate to a 7–25% decrease in the number of unintended pregnancies.

The researchers then estimated cost savings under each scenario by comparing the total public sector costs of providing OCPs OTC and of providing medical care for unintended pregnancy. They found that the combined costs would be reduced for public health plans covering oral contraceptives as an OTC product.

The implications are twofold. Interest in OTC access to oral contraceptives is high. Removing the prescription barrier, particularly if pill packs are available at low or zero out-of-pocket cost, could increase the use of effective methods of contraception and reduce both the rates of unintended pregnancy and the healthcare costs associated with contraceptive and pregnancy care.

New ANSIRH study published in Obstetrics & Gynecology shows that major complications after abortion are extremely rare

In the most comprehensive look yet at the safety of abortion, ANSIRH researchers have found that major complications occur in less than a quarter of a percent of all abortions, about the same frequency as major complications in colonoscopies. The study, published online on Monday, Dec. 8, 2014, in Obstetrics & Gynecology, analyzed data from more than 50,000 women enrolled in the Medi-Cal fee-for-service program who obtained abortions from 2009 to 2010, and looked for complications that occurred within six weeks of the procedure.

The rate is similar to what has been found in previous studies, but this is the first study in which researchers have based their conclusions on complete data on all of the health care used by women who have received abortions. Since some women must travel long distances to find abortion providers, they tend to receive follow-up care at facilities closer to where they live. For many women, this means their local emergency department. But, up until now, no study has systematically examined emergency department use for post-abortion care.

“Our study had very complete follow-up data on all of the women in it, and we still found a very low complication rate,” said Ushma Upadhyay, PhD, MPH, the lead author of the study. “Abortion is very safe as currently performed, which calls into question the need for additional regulations that purportedly aim to improve safety.”

Other authors of the study include Tracy A. Weitz, PhD, MPA, and Patricia Anderson, MPH, of ANSIRH; Sheila Desai, MPH, who did the research while at ANSIRH; Diana Taylor PhD, RNP, an emeritus professor in the UCSF School of Nursing; Daniel Grossman, MD, of the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences and Ibis Reproductive Health; and Vera Zlidar, MHS, who did the research while at John Snow, Inc.

The researchers said they expect the study to contribute to the national debate over abortion safety. Many state legislatures have recently passed laws that have the effect of reducing access to abortion by requiring providers to have transfer agreements or admitting privileges with hospitals or to construct their clinics so that they meet the requirements of an ambulatory surgical center. But the researchers said that these restrictions were likely to make women travel further to get abortions or induce them on their own using unsafe methods, both of which may increase the risks for women.

Carole Joffe publishes new textbook, Reproduction and Society

ANSIRH research and faculty member, Carole Joffe, PhD, releases her latest book, Reproduction and Society: Interdisciplinary Readings, on September 15, 2014. Framed with original introductions, Reproduction and Society is a collection of essays edited by Joffe and Jennifer Reich, PhD,that includes selections by present and past members of the UCSF ANSIRH and Bixby Center for Global Reproductive Health communities: Lori Freedman, PhD; Tracy Weitz, PhD; Naomi Stotland, MD (writing about the prison work of Carolyn Sufrin, MD), as well as Joffe herself. Divided into six rich and varied sections, this book offers students and instructors a broad overview of the social meanings of reproduction and offers opportunities to explore significant questions of how resources are allocated, individuals are regulated, and how very much is at stake as people and communities aim to determine their own family size and reproductive experiences. This is an ideal core text for courses on reproduction, sexuality, gender, the family, and public health.

The annual Cushner Lectureship is awarded to a layperson, public figure, or health care professional who has raised public awareness and inspired public policy debate regarding a pressing current issue in the field of health care, especially one pertaining to reproductive health. It is named after Dr. Irvin Cushner, who helped develop the field of social obstetrics and guidelines for the legalization of abortion in the state of Maryland. Dr. Cushner served as deputy assistant secretary for population affairs for the U.S. Department of Health, Education, and Welfare.

Congratulations, Tracy!

ANSIRH seeking new Director

ANSIRH is seeking a new Director, which will be a faculty position within the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences.

ANSIRH works to ensure that reproductive health care and policy are grounded in evidence. The Director will lead ANSIRH’s multi-disciplinary team, which includes clinicians, researchers and scholars in the fields of sociology, public health, demography, epidemiology, psychology, and nursing. We seek:

A researcher (MD, PhD or DrPH) with extensive experience and a distinguished publication record in abortion and reproductive health research.

A collaborative leader who will guide the organizational development of ANSIRH, cultivate an identity beyond the collection of individual research projects, and identify new opportunities and funding sources for ANSIRH. The Director would also represent ANSIRH credibly and compellingly to the public, the University, the media, and others working in the field.

A mentor who can ensure mentorship of staff and faculty at all levels of the organization, establishing structures for nurturing career/research development and growth.

Diana Taylor honored with inaugural Hysterical Hero Award

Diana Taylor is the recipient of the inaugural Hysterical Hero Award at the 2014 Hysteria Benefit for the Women’s Community Clinic. Taylor is a longtime Board Member, volunteer clinician, and tireless advocate for the Clinic.

“We built the kind of place where we want to receive care,” Taylor says. “The Clinic has been volunteer-driven since our opening; our volunteers are incredible – lay volunteers who are passionate about educating women about improving their health as well as the expert nurses and doctors who volunteer so they can provide care the way we believe it should be provided!”

“The Clinic not only fills an important need but is educating women to take care of themselves and training future health professionals,” she says. “We believe health is wealth and that women’s health means family and community health.”

Congratulations for a much-deserved award, Diana!

Tracy Weitz receives 2014 ACN Vision Award

The Abortion Care Network (ACN) holds an annual meeting in which they honor three individuals who exemplify excellence in our field. This year ACN dedicated its 2014 Conference to the Center for Reproductive Rights for its extraordinary advocacy for independent clinics and its visionary campaigns to end the stigmatization of abortion. ACN honored Amy Hagstrom-Miller, CEO of Whole Woman’s Health with the David Gunn Lifetime Achievement Award; Tracy Weitz, former Director of ANSIRH, with the Vision Award; and Jodi Jacobson of RH Reality Check with the ACN Person of the Year Award.

The Vision Award, given to “person or persons who challenge the stigma of abortion in every day practice,” was awarded to our own Tracy Weitz for her creativity and leadership in her years as Director of ANSIRH.

Congratulations, Tracy!

Katrina Kimport publishes new book, Queering Marriage

As we celebrate Freedom to Marry Day on February 12th, we also celebrate the recently published book by ANSIRH research and faculty member Katrina Kimport, PhD. In Queering Marriage: Challenging Family Formation in the United States, Kimport uses in-depth interviews with participants in the San Francisco weddings to argue that same-sex marriage cannot be understood as simply entrenching or contesting heterosexual privilege. Instead, she contends, these new legally sanctioned relationships can both reinforce as well as disrupt the association of marriage and heterosexuality.

During her deeply personal conversations with same-sex spouses, Kimport learned that the majority of respondents did characterize their marriages as an opportunity to contest heterosexual privilege. Yet, in a seeming contradiction, nearly as many also cited their desire for access to the normative benefits of matrimony, including social recognition and legal rights. Kimport’s research revealed that the pattern of ascribing meaning to marriage varied by parenthood status and, in turn, by gender. Lesbian parents were more likely to embrace normative meanings for their unions; those who are not parents were more likely to define their relationships as attempts to contest dominant understandings of marriage.

By posing the question – can queers “queer” marriage? – Kimport provides a nuanced, accessible, and theoretically grounded framework for understanding the powerful effect of heterosexual expectations on both sexual and social categories.

Today Governor Jerry Brown signed Assembly Bill 154 (AB154). AB154 removes barriers to abortion provision for nurse practitioners, certified nurse midwives, and physician assistants, allowing them to perform to the fullest extent of their education and competency and provide more comprehensive reproductive health care for women throughout California.

The bill is based on ANSIRH’s six-year study, Health Workforce Pilot Project #171, which showed that these skilled health professionals can safely and competently provide early abortion care and that women appreciated receiving care in their own communities from providers they know and trust. ANSIRH is proud that our research played a part in an important law change in California that will remove barriers to abortion provision for advance practice nurses and physician assistants and help to increase access to needed services throughout the state.

Carole Joffe receives SFP 2013 Lifetime Achievement Award

ANSIRH research and faculty member Carole Joffe, PhD, has been awarded the Society of Family Planning’s Lifetime Achievement Award. The award was established in 2005 to honor outstanding individuals whose cumulative research has reached the highest level of importance in the field. It is one of only three awards that SFP grants yearly. Awardees are chosen for scholarship over the majority of a career that advances clinical or social science within family planning—especially work that creates a foundation for others to achieve academic success or provides clinical information and resources that help women with reproductive issues specific to family planning.

New Turnaway Study data published in AJPH identifies barriers resulting in thousands of US women being denied abortions each year

Results of key data from the Turnaway Study show that the main reason women delay seeking abortions is having to raise money for travel and procedure costs. That delay means every year at least 4,000 US women are turned away from facilities due to gestational age limits and must carry their unwanted pregnancies to term. The analysis of the data is published in a peer-reviewed article in the American Journal of Public Health entitled “Denial of Abortion Due to Gestational Age Limits in the United States.”

Delays in seeking abortions are primarily due to costs, with young and poor women being the most affected. Nearly half of the women who sought a second trimester abortion didn’t even know they were pregnant until they were in the second trimester, and about 10% didn’t know until after 20 weeks. Once women are late in discovering they are pregnant, everything else is more difficult—there are fewer providers who offer later abortions; they have to travel farther and pay more to get the procedure, which leads to more delays. With new state laws imposing lower gestational age limits for abortion care, more and more women will face these barriers and will have to carry unwanted pregnancies to term.

Conclusions from the study:

Women seeking later abortions tend to be younger and recognize their pregnancies later.

Women in need of second-trimester abortions are particularly vulnerable insofar as there are fewer providers that offer these services, and when they are available, procedures typically cost several hundred, or even thousands, dollars more than a first-trimester procedure.

As more states approve laws that impose lower and lower gestational limits, more women will face these burdens, leading to even more unintended births.